Individual
MISTY KELSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 NE ANDERSON LN, LEES SUMMIT, MO 64064-1244
(913) 263-6006
Mailing address
8702 W 49TH TER, MERRIAM, KS 66203-1710
(913) 263-6006
(816) 836-2923
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10670
KS
104100000X
Social Worker
Primary
2022040360
MO
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K112105027
DRIVER'S LICENSE
MO
Enumeration date
11/09/2022
Last updated
11/09/2022
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